Levosimendan versus Dobutamine in Heart Failure Patients Treated Chronically with Carvedilol

Abstract

Introduction: Although beta-blockers are highly effective in the treatment of heart failure (HF), many patients with HF receiving a beta-blocker continue to become decompensated and require hospitalization for worsening HF. Levosimendan and dobutamine are used to manage decompensated HF, but their comparative effects on left ventricular (LV) function in patients prescribed beta-blockers are unknown. Aims: The aim of this study was to compare the effects of dobutamine and levosimendan on LV systolic and diastolic functions in chronic HF patients treated chronically with carvedilol. Forty patients with chronic HF who had NYHA class III to IV symptoms, a LV ejection fraction (LVEF) <40%, and ongoing treatment with carvedilol were enrolled in this randomized (1:1), dobutamine controlled, open-label study. Before and 24 h after treatment, LVEF, mitral inflow peak E and A wave velocity, E/A ratio, the deceleration time of the E wave (DT), isovolumic relaxation time (IVRT), peak systolic (Sm) and early diastolic (Em) mitral annular velocity, and systolic pulmonary artery pressure (SPAP) were measured by echocardiography. Results: Levosimendan produced a statistically significant increase in LVEF (28 ± 5% vs. 33 ± 3%), Sm (6.5 ± 1.2 cm/s vs. 7.4 ± 0.9 cm/s), DT (120 ± 10 ms vs. 140 ± 15 ms), and Em (7.5 ± 0.4 cm/s vs. 8.1 ± 0.5 cm/s) and significant decrease in E/A ratio (2.1 ± 0.3 vs. 1.7 ± 0.4) and SPAP (55 ± 5 mmHg vs. 40 ± 7 mmHg). No significant change occurred in LV systolic and diastolic function parameters, or SPAP with dobutamine treatment. Levosimendan did not significantly alter the heart rate (72 ± 4 bpm vs. 70 ± 3 bpm), systolic (105 ± 5 mmHg vs. 102 ± 4 mmHg), or diastolic blood pressure (85 ± 5 mmHg vs. 83 ± 5 mmHg) whereas with dobutamine treatment, all these parameters significantly increased. Conclusions: Dobutamine and levosimendan have different effects on LV functions in patients treated chronically with carvedilol. These differences should be considered when selecting inotropic therapy for decompensated HF receiving long-term carvedilol. What's already known about this topic?Although beta-blockers are highly effective in the treatment of heart failure (HF), many patients receiving a beta-blocker continue to become decompensated and require hospitalization for worsening HF. Levosimendan and dobutamine are used to manage decompensated HF, but their comparative effects on left ventricular (LV) function in patients prescribed a beta-blocker are unknown. What does this article add?This study demonstrates several important differences between levosimendan and dobutamine in carvediloltreated patients. Levosimendan infusion improved LV Levosimendan in Heart Failure Patients Treated with Carvedilol systolic and diastolic functions, and systolic pulmonary artery pressure (SPAP). Levosimendan did not alter the heart rate, systolic, or diastolic blood pressure. With dobutamine treatment, the patients responded with an increase in heart rate, systolic, and diastolic blood pressure while LV systolic and diastoli...

Effects of Dobutamine and Levosimendan on Systolic Time Intervals in Patients with Decompensated Heart Failure

“…In a study involving 40 patients with decompensated HF, Duygu H et al observed significant increases in LVEF, Sm, Dt, and Em and significant decrease in E/A ratio and systolic pulmonary artery pressure (SPAP) among subjects receiving levosimendan as compared to those receiving dobutamine. In dobutamine patients, no significant alterations were found in systolic and diastolic LV parameters as well as in SPAP 13 . In our study, lateral and septal Sm velocity showed a significant increase following both inotropic agents, with no significant between-group differences.…”

“…This was the only significant treatment-related electrolyte alteration in our patients. Duman D et al compared the effects of dobutamine and levosimendan on SBP, DBP, and HR and found no significant differences 12, while Duygu H et al observed a significant increase in these three parameters in dobutamine patients, with no significant changes with levosimendan 13 . In our study, dobutamine treated patients had an average increase of 11 mmHg in SBP as compared to a 16.7 mmHg reduction in levosimendan treated patients, suggesting a predilection toward hypertension and hypotension for these two treatments, respectively.…”

Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure

“…In studies comparing levosimendan and dobutamine, some showed significant improvement in LVEF [15,20,21] both with levosimendan and dobutamine, but in a study in which patients were treated with carvedilol [17], the dobutamine group did not show an improvement in LVEF. In our study, LVEF significantly improved in the levosimendan group, but not in the dobutamine group.…”

“…Studies comparing levosimendan and dobutamine using echocardiographic parameters generally performed a second echocardiographic examination just after inotrope infusions [15][16][17]. We performed echocardiographic measurements 5 days after the initiation of infusions to determine whether the favorable effects of the levosimendan and dobutamine continue following infusions.…”

Levosimendan Optimal Medikal Tedavi Alan Dekompanse Kalp Yetersizliği Hastalarında NTproBNP Seviyesini ve Ekokardiyografik Parametreleri Düzeltir

“…Thus, there is potential benefit of combined therapy with beta-blockers and levosimendan when compared to dobutamin (14) . Accordingly, some recent trials presented beneficial hemodynamic effects of levosimendan in comparison to dobutamine in patients with acute decompensated HF treated with beta-blockers (15)(16)(17) . We, in this study, successfully used levosimendan in decompensated HF patients treated concomitantly with beta-blocker drugs.…”